relationships

Mum’s the problem.

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Recently I have met a Professor of Psychotherapy, a Consultant Psychiatrist and a GP – all parents of children lost to mental illnesses. Here’s what one mum says:

“Whenever I have seen a therapist, they have gone straight to my childhood, my up-bringing, my parents and their parents. All my behaviours and feelings seem to be explained and understood based on their behaviours, however ‘normal’, for their times. I am encouraged to think of all the ways in which they could have directly or indirectly damaged me.

By that principle, all of my child’s behaviours and feelings should be explained and understood based on the behaviours of his parents. Half of them is me. I agree. I must be part of the problem. My profession is perceived as a bigger problem. ‘High achieving Asian’ parents are assumed to put a lot of pressure on their children. So much so, the medics looking after him didn’t even need to meet me or know the quality of our relationship to be certain that my job makes me a bigger problem than most other mums. They could squarely put the blame on me and actively keep me out of the picture. I asked too many questions. I was the biggest problem. They wrote it in their notes.

However, that does not mean that I cannot be part of the solution. NICE guidelines lay out my role beautifully but do the people on ground read any of these guidelines? In my experience, not. If half of all that is written in Policies and guidelines was implemented, families could engage meaningfully in helping their kids recover.”

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Ref: https://www.nice.org.uk/guidance/cg185/chapter/1-Recommendations#recognising-diagnosing-and-managing-bipolar-disorder-in-children-and-young-people-2

Visiting my adolescence

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Innkeeper's wife

(The mean, very mean wife of the inn-keeper. Nativity play 1983. CMC Ludhiana. India.)

Once upon a time I used to be a kid. A bright and happy kid. I nearly forgot that girl. She used to be fun. She loved singing, dancing and play-acting. She had thick black, unusually curly, short hair. She laughed easily and played harmless pranks. She listened to music on the radio with such ardour that her day was planned around the timings of her favourite programmes on the Urdu service of All India Radio. The last few pages of all her notebooks were filled with scribbled lyrics of songs written at speed to keep pace with them as they played on the old Murphy which was a part of her mother’s dowry. Then she neatly transcribed the messy song-words from the back pages of her notebooks onto a special red diary which was her treasure.

A few months back I accepted an invitation from my alma mater, Christian Medical College, Ludhiana, India.  This is where I trained to be a doctor and an anaesthetist, nearly 30 years ago. They requested me to run a Mental Health workshop for about 70 medical students and make a Keynote address at the World Junior Medical Congress they were hosting in early April.

While preparing my lecture, I dug up a few old pictures. They flew me back in time. I saw what I looked like when I was Saagar’s age. It was a strange juxtaposition. So much had changed. Oh, that heart-breaking innocence! The stars in my eyes shone so bright, they nearly blinded me. Who was this lovely girl? Where is she now? She has walked a long way and formed a big circle. She is back where she started, working with what she has – her Love, her Grief and her Self.

MH Workshop

The workshop was four and a half hours long. The sharing was powerful, the enthusiasm infectious. The learning for all of us was invaluable. It was fun! We sang and we danced. We worked and we played. It was just like the old times. Saagar was there. He was smiling his crooked smile.

“There is nothing in the world, I venture to say, that would so effectively help one to survive even the worst conditions as the knowledge that there is a meaning in one’s life.” – Victor Frankl.

 

 

 

 

 

 

 

Thank you, Mr Bronx.

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He came to us as a little girl in 2004, from Antrim Animal Sactuary. We called him ‘Bella’ for a week before the vet told us he was a little boy. One of his ears had a wedge missing, a sign of having lived rough. That didn’t take his sweetness away. He jumped to the top of kitchen cabinets and mewed in protest for being locked up indoors. He loved being outside in the sun, watching the world go by and making friends with it. He played with anything – hair, wool, food, the mint plant, newspapers, laptops. He brought a light and joyful energy into our house.

He slept under my bed and some mornings I woke up, looking straight into his eyes. We had long conversations where each of us listened and allowed a gap after the other finished their sentence before starting to speak. Saagar was endlessly amused by this intimate interaction beyond language, where everything was being expressed and understood. In the evening, while I sat watching TV, Mr Bronx sat watching me.

Stroking him saved my life. He received love generously. That alone was enough.

He happily adopted the neighbours by pretending he wasn’t being fed at home. One day I found a note through my door. ‘Please feed your cat’ it said. Later I also found out that one of my lovely neighbours had set up a Facebook page to find support for this poor black and white cat on his street! Thank you, Bronx!!!

A few months ago the vet said that his thyroid and kidneys were not working very well. She put him on a special diet and some meds. We ran some blood tests, which indicated that he was slowly approaching the end of his life. So, we made the most of our time together, playing and eating and a lot of loving. Si found out Mr Bronx loved organic chicken. He treated him and himself to it often.

Last Friday Mr Bronx got a bit wobbly on his feet. On Saturday, all he wanted was to lie down. We spent the whole day together in the sun, listening to music and Radio 4, saying hello to passers-by and talking. That night he peacefully slipped away in his sleep. He now rests in his favourite place, our garden. Love you, Mr Bronx. Thank you.

Just beneath the skin

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Dissecting a human body is an enlightening experience. At 17, in the first year of medical school, it was a shock to enter the massive Anatomy hall with 12 metallic rectangular tables, each occupied by a horizontal naked human body covered with a white cotton sheet. 4 students in alphabetical order, to a table/ body. All different but more or less the same, students and bodies. Mine was a dark skinned, muscular young man in his thirties. I wondered how he had landed up on this table in the heart of Punjab when he clearly belonged somewhere else. I wondered what his story was.

The air was suffused with a stench of formaline. It flew through the roof of my nose straight into the recesses of my gray matter to form unerasable maps. It stung the eyes so hard, they wept. I never thought it was possible to get used to that repugnant odour but by the end of the first week, it was a ‘normal’ part of me.

‘Upper limb and breast’ was the first Lesson. Anterior, posterior, medial, dorsal, ventral lateral, proximal, distal were some of the new words added to my word bank. When I took the scalpel to my man’s skin, I flinched. It was an invasion. A sacrifice. An offering. A permission. I wanted to apologise to him and thank him. As I carefully peeled the first layer off, a pale yellow silky layer unravelled itself. I peeked at the next table and it was the same. And the next and the next. Men and women, old and young, squat and fit, brown and black. Whatever on the outside, were the same just underneath. The other thing they had in common was that they were all dead.

It’s the same with us. Whatever we are on the outside, we’re the same just underneath. We cry the same salty tears, we feel the same love for our kids, we yawn and sneeze and hiccup and breath the same way. We all are distinct and yet, more or less the same. Our innermost desire is only to be loved and understood. And one day we will all be dead.

At present, with the identity politics at its peak, my kind, gentle and fairness-loving husband is made to belong to only one box, that of a straight middle-aged white man. Yet, he is so much more than that. Just as black people are so much more than just black and homosexuals are so much more than just that. And Saagar was so much more than just a brown young man.

Underneath all that they all are just human. We have the privilege of living on the most gorgeous planet. Our numbers are higher than ever before and our potential as a race is the highest it has ever been. Yet, we cannot find one suitable host for the Oscars Award ceremony. Because we have paralysed ourselves. We cannot allow people the smallest past or future mistakes and mis-judgements. The amount of energy spent on getting offended or apologising for mistakenly causing offence is frightfully high.

At a time when we need more cohesion between humans than ever before, we are building divisions all over the world – us and them. Be it ‘the wall’ in America or Brexit or Islamophobia. We need bridges, not walls. We need to see ourselves in others – vulnerable and tough at the same time.

Can we make an effort to find the sameness between us? I may be a hippie and you a hipster but we are not that different. Let’s talk.

Help? Me?

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“Call for help” is the first step in Basic Life Support. At the hospital, I encourage Junior doctors to recognise early when a patient is too complex or too sick and ask for help at an early, rather than late stage.

It took six sessions of counselling to wake me up with a jolt to the fact that I needed to ask for help. Yes. I was a strong and independent woman. Yes. Very self-sufficient. Omnipotent, in my view. I offered help generously but hesitated to ask. Saagar was ill. I was looking after him the best I could while working full time. All our family was in India.  Saagar’s dad stepped in as much as he could. He worked full time too. We had no back-up. No support net-work. No community. We were muddling along till it dawned on me after 6 weekly Talking Therapy sessions of one hour each, that I could and should ask my family for help even though they were thousands of miles away.

I didn’t know it then, but it would seem I didn’t like asking for help. It made me feel weak, vulnerable and inadequate. Exposed. I don’t know why but it seemed like an admission of failure to manage my affairs. But now, Saagar was ill and we needed help.

On the night of the last session of therapy, I wrote an e-mail to all the adults on my side of the family, explaining our situation and finally, asking them for help.

One of my brothers responded. He applied for his UK Visa at once. A few days later he was told there weren’t enough blank pages in his Passport for the Visa to be stamped. He took the document back to the Passport office to get more blank pages added on. That took a few days. He then re-applied for his UK visa and finally got it a further few days later. By now 2 more weeks had passed.

In the mean time I arranged with one of my young friends, Jan to come to stay with us. Jan and his mum attended meditation lessons with me. Jan was a compassionate and enthusiastic young man who had recently lost his job and was looking for something meaningful to do. I offered him our guest room and invited him to stay with us, explaining the situation. He was excited about it. I asked Saagar how he felt about this temporary arrangement.

“It’s okay Mamma. I’ll wait for Uncle to come.”

I listened. I understood. I was tempted to push it. But I wanted to respect Saagar’s wishes. I didn’t want to take away the little control over his life that he had left.

A few days later, the visa arrived. Just in time for Saagar’s uncle to attend his funeral.

Moral of the story: Ask for help openly and EARLY.
Reminder: It takes a village …

Song: Lean on me:

https: //www.youtube.com/watch?v=qTVEIOOBD6Q

My name is Saagar.

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S A A G A R.

In Delhi, it was simple and sweet. In Belfast, it had to be spoken out slowly and spelt out clearly. Still, it was utterred in all kinds of ways- Segaar, Sags, Sagsy-Wagsy, Saga, Cigar etc. It is, after all, a proper noun. I would think forgivingly, “As long as you speak his name with love, you can say it any which way you like.”

At about 7 years of age, Saagar came home from school one day and casually, asked “Can’t I be called Aran or something?” I felt for him but laughed. What else could I do? I asked him if anyone had commented on his name at school that day. “I have to tell them at least twice and then spell it out and they still get it wrong.”

I told him the story of his name. I was 24 when I got married. My in-laws lived In Chennai. We visited them a few months later and one evening we all went to a place called Besant Nagar beach. That was the first time I saw the ocean. The vision of a dark blue shimmer below meeting a pale blue glow above in a clean, delicate, straight line made everything else disappear. Its calm, its rhythm, its enormity, its subtle dance, its grace and openness pulled me in. All people and conversation faded away and there I was, completely soaked in the bliss of the ocean. My soul soothed. My body relaxed. My eyes quenched. I was in love. In that moment, I knew that if I ever had a son, he would be called, ‘Ocean’ ie. Saagar.  I told him he was named Saagar because his heart was as large and as beautiful as the ocean. He smiled and hugged me tight.

Saagar and I needed more stories. They could give us a sense of connection with the characters and each other. Feel their excitement and face their challenges.  Make us less alone. Create pictures we could step into as characters. They could show us a map of how to get from here to there. Of how to live in this world. They could make us more human, creating boundaries and arenas within which we could shine. They could make things seem less endless and random. They could take us places we didn’t know we wanted to go. We needed more shared stories.

 

No more; no less.

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It occurred to Pooh 🐻 and Piglet 🐷 that they hadn’t heard from Eeyore for several days, so they put on their hats 🎩 and coats 🧥 and trotted across the Hundred Acre Wood🌲 to Eeyore’s stick house. Inside the house was Eeyore.

“Hello Eeyore,” said Pooh.

“Hello Pooh. 🐻 Hello Piglet 🐷” said Eeyore, in a Glum Sounding Voice

“We just thought we’d check in on you,” said Piglet, “because we hadn’t heard from you, and so we wanted to know if you were okay.”

Eeyore was silent for a moment. “Am I okay?” he asked, eventually. “Well, I don’t know, to be honest. Are any of us really okay? That’s what I ask myself. All I can tell you, Pooh and Piglet, is that right now I feel really rather Sad, and Alone, and Not Much Fun To Be Around At All.

Which is why I haven’t bothered you. Because you wouldn’t want to waste your time hanging out with someone who is Sad, and Alone, and Not Much Fun To Be Around At All, would you now.”

Pooh looked and Piglet, and Piglet looked at Pooh, and they both sat down, one on either side of Eeyore in his stick house.

Eeyore looked at them in surprise. “What are you doing?”

“We’re sitting here with you,” said Pooh, “because we are your friends. And true friends don’t care if someone is feeling Sad, or Alone, or Not Much Fun To Be Around At All. True friends are there for you anyway. And so here we are.” 💜💚

“Oh,” said Eeyore. “Oh.” And the three of them sat there in silence, and while Pooh and Piglet said nothing at all; somehow, almost imperceptibly, Eeyore started to feel a very tiny little bit better. 🥰

Because Pooh and Piglet were There.
No more; no less.

A.A.Milne
E.H.Shepard

Andy’s dilemma. Errm … decision.

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On Friday, the first thing I heard on radio was Andy in tears. It was also the last thing on TV before going to bed. A proud Scotsman, 31 years of age, Andy announces his retirement after a scintillating career in tennis and a long fight with an injury to his right hip. Tall and athletic, in a deep blue t-shirt, seated in front of a dark grey screen covered in contrasting logos, he faced the press. Eyes lowered. Head bent. His left hand trying to cover his face in the guise of adjusting the brim of his baseball cap.
“Ermm. Not great.” (Nods, looks sideways, down and to his right. Nods twice to himself. Big sigh.)
“Ermm…”(Comes close to breaking down and leaves his seat. Walks off with head steeply bent forward.)
Comes back. Sits down. Starts again.
“Sorry.” (Small cough)
“Ermm. Yeah. So, not … not feeling good.
Obviously been struggling, been struggling for a long time.
I can still play to a level. Not a level I’m happy playing at. But also, it’s not just that the pain is … too much really. I don’t want to keep playing that way. You know, I spoke to my team and I told them that, you know, I can’t … I can’t keep doing this and I needed to have an endpoint. I told my team that I needed to get through this till Wimbledon. That’s where … where I’d like to stop.
Ermm … stop playing. (Visibly steels himself as he says this).
Ermm … but also not certain I’m able to do that. (Shakes his head and bends it further forward)
Ya. Ya. I think there’s a chance of that for sure. (Rubs his right eye. Purses his lips.)
Ermm. Ya. There’s … sure, because like I said I am not sure … not sure I’m able to … to play through the pain you know. For another 4-5 months. Ermm. I have an option to, you know, have another operation which you know is … you know a little bit more … more kind of severe than what I’ve had before and having my hip resurfaced will allow me to have a better quality of life and be out of pain and that’s something I’m seriously considering right now. There’s obviously no guarantees. The reason for having an operation like that is not to return to professional sport. It’s just for a better quality of life. Yeah. For myself mainly. (Pulls the brim of his hat forward). There’s lots of little things. I mean, you guys see me running around the tennis court and walking around in between points and it obviously doesn’t look good and doesn’t look comfortable but you know there’s little things like day to day, that are also a struggle, and ya, it’d be nice to be able to do them without any pain. Putting your shoes on, socks on – things like that. Having the limitations and the pain is not allowing me to enjoy competing or training or any of the stuff that (shrugs) I love about tennis.
Nothing helps. You’re in lots and lots of pain. You can’t do what you want to do, what you love doing. I can do it but it’s not fun. I’m not enjoying doing it. So … I mean. That’s what I’ve done. Tried to deal with it, talk about it. Ermm. But none of that makes my hip feel better unfortunately. I wish it did, cause if it did, I’d be feeling brilliant just now but it doesn’t. So…” (Gets up and leaves.)

His deep sense of loss, confusion, pain and vulnerability came across clearly. It’s probably one of the hardest decisions of his life. I visualise a society, our society, creating space for such expression, not just for physical but also emotional pain. It’s going to be a tricky transition. I am sure he has the required support network in place. Good luck Andy!

Ref: https://www.theguardian.com/sport/2019/jan/13/andy-murray-tennis-retirement

 

Needs, needs …

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Alexander Maslow called himself a Humanistic Psychologist. He had a special interest in the relationship between the human mind and human potential. He is known by the model of human needs he proposed, Maslow’s Triangle.

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Starting from below, the first 4 needs are classed as ‘Basic’ needs. They are essential to survival and yet, unmet for a large proportion of the world population. The order of needs is not meant to be strictly from the base to the tip of the pyramid. Many of them are of importance simultaneously. At different times, one can be more important than the other. Self-actualization is put forward as a ‘Being’ need, to connect with something beyond survival of the ‘ego’, to find self-fulfillment and help others find the same.

I read ‘morality’ as ‘authenticity’ – being aligned with my true values and self. For me it’s not about abiding by a religious doctrine or an external diktat.

When Saagar was alive, I spent most of my time in meeting our ‘basic’ needs, often sacrificing one for another. Moving away from friends and family, spending long hours at work, fighting stiff competition to move forward professionally, not making time for my hobbies, friends and relaxation, constantly chasing time, worrying about running a house-hold.

Since Saagar’s passing, I have had glimpses of ‘self-actualization’. I have been able to connect with myself and others authentically. I have a desire to know and understand the meaning of being human at a deeper level. My creativity has found expression. I have experienced transient moments of transcendence, which cannot be described in words. I have been able to appreciate beauty in flowers, leaves and poetry like never before. Retrospectively, I have been able to see that Saagar could not meet any of his needs except the most basic when he was severely depressed and that must have been crushingly painful for him.

I wish it didn’t take something so terrible, to make us see things clearly.

The Cats

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(Merry Christmas from Milkshake)

The Intensive Care Unit (ICU) at the City Hospital was a circus. A different clown (read Consultant) was in-charge everyday. What was right on a Monday was completely wrong on a Tuesday. The same action would be pronounced as ‘perfect’ by one clown and ‘abhorrent’ by another. To make things better, they didn’t talk to each other. The flunkies (read junior doctors) were the in-betweeners that got lammed from both sides as their shifts crossed over time-territories. They were the pawns on the frontline that took over the running of the unit from one clown at the beginning of a shift and handed over to the other at the end. They were the ones dodging the arrows of conflict over phones, in hospital corridors and at handovers. They were the ones that stayed up all night working hard, only to be abused and criticised the next morning. They were the buckets into which bile was poured, the bile of bitterness that the clowns didn’t have the guts to express to each other.

In 2004, I was one of those flunkies. After about 8 months of this non-sense, I was done. I was loosing my sense of self, my confidence in making decisions and most importantly,  pride in my job. It was time to stop and take stock. After a nasty night shift, I was handing over the patients to the day team. I am sure at one point I heard the Consultant taking over suggest to me ‘you need your head examined’.  That did it for me. Bleary-eyed and broken, I couldn’t bear to go home only to come back to this toxic work environment yet again that night. I planted myself in Psychiatry Outpatient Department and demanded to be seen by someone. Dr Ingram was a handsome, young psychiatrist with kind eyes and a small beer belly, well couched in his grey suit. He understood. I was given 6 weeks of work-related-stress leave and started on Fluoxetine. I was also seen by an occupational therapist once every fortnight. She suggested getting a cat.

At the local Animal rescue home, we found an enchanting black and white, one year old feline. It was her eyes that got me – talking and smiling eyes. We were told it was a girl. We decided to call her Bella. We were advised to keep her strictly indoors for at least 6 weeks, till she got used to the smells in the house. She found her way to the strangest of places –  on top of kitchen cabinets and radiator covers, squeezed behind and underneath beds, chairs and sofas, inside shoes and boxes. The only place she didn’t like was her soft furry blanketed bed.

On our first trip to the vet for a basic check-up and vaccinations, we found out that the she-cat was in fact a he-cat. After much consultation, he was christened ‘Mr Bronx’, the old faithful. He soon became a source of great joy, comfort and hilarity for the family. We had him go crazy playing with balls of wool, soft toys with tiny in-built bells and laser beams. He was pure entertainment from a distance at the beginning but slowly he allowed us to stroke and cuddle him. Within a month we were having full-fledged conversations with him.

The Fluoxetine made me feel frozen. Hollow. No joy. No pain. No love. It was dehumanising and unbearable at times. It was proof that pills alone cannot make you happy. After 6 weeks, it was time to go back to work. I did. A cunning plan was put into place so that I didn’t spend too much time at the ICU. It worked.

9 years later, Saagar was home from University and I got a phone call from him at work. He said he’d found a cat on ‘Gumtree’ and he would love to get it. That evening we went over to a tiny flat in Sydenham occupied by a family of 4 – mum and 3 kids. On a window sill lounged another family of 4, a grey mother-cat with her three grey kittens, 6 weeks old. One of the malnourished kids was about 3. He handled the kittens like rags. He didn’t care if he lifted them by their ears or tails or bellies. He let them go from various heights above the floor, cornered and held them with a lot of force. He told us all about what the cats ate. We picked the cutest little kitten who resembled a mini-punk, got it properly accessorised and brought “Milkshake” home. He was Saagar’s baby that summer.

Not once did it occur to me that there might be a connection between the circumstances under which we got the first cat and the second.

Ref: https://www.cats.org.uk/news/purring-the-blues-away